Prostate cancer: FAQs

The numbers tell the story. Every day, 12 Canadian men die of prostate cancer. One in six men develop the disease in their lifetime. About 25,000 Canadians were diagnosed with it in 2009.

It is the most common cancer found in men and the second-most deadly, after lung cancer. Yet two of three Canadians who develop the disease will die of something else. It remains one of the most treatable cancers, if caught early enough.

What is the prostate?

It's a small, round organ below the bladder and in front of the rectum in men. It surrounds part of the urethra, the tube that carries urine from the bladder.

The prostate produces secretions that provide nutrients to sperm. It also provides the muscle power needed when the sperm leaves the penis during ejaculation.

The prostate is about 30 per cent muscular tissue; the rest is glandular tissue.

Like most organs, the prostate continues to grow and develop after birth. By the time males have reached physical maturity in their late teens, the prostate is about the size of a walnut and stops growing.

But by about age 60, it can start growing again. By age 70, almost all men will have an enlarged prostate.

Why is an enlarged prostate a problem?

Because the prostate surrounds the urethra, an enlarged prostate can cause problems if it exerts pressure on the urethra. That can slow or weaken the flow of urine.

Is an enlarged prostate the same as prostate cancer?

No. An enlarged prostate could lead to a condition called benign prostatic hypertrophy (BPH), or prostatitis.

What is BPH?

Simply, it is the enlargement of the prostate. It usually occurs in men older than 50. It can result in a gradual squeezing of the urethra, with symptoms that can include: 

• A weak urinary stream.
• Difficulty starting urination. 
• Frequent urination.
• Getting up frequently through the night to urinate. 
• Feeling like you still need to go after you've gone. 
• Inability to urinate.

The condition can be treated through medication, if your doctor decides that your condition is troubling. Often the first step is just to monitor the condition. Symptoms will sometimes diminish on their own. Other treatments include heat therapy to destroy excess tissue, or surgery to remove enough tissue to relieve the blockage that affects urination.

What is prostatitis?

Prostatitis is an inflammation of the prostate gland and is one of the most common urological conditions diagnosed in young and middle-aged men. It accounts for about 25 per cent of all visits to urologists. There are three major types of prostatitis: 

• Acute bacterial prostatitis: a sudden infection of the prostate gland, caused by bacteria. Symptoms may include fever and chills, pain in the lower back or rectum, and/or urinary symptoms. 
• Chronic bacterial prostatitis: the prostate gets inflamed over and over again. Symptoms may be similar but milder than acute prostatitis, and can last longer. 
• Nonbacterial prostatitis: inflammation of the prostate for which the cause of the inflammation cannot be found.
• Bacterial prostatitis — acute or chronic — is usually treated with antibiotics. Treatment for nonbacterial prostatitis involves medications to reduce the difficulty in urination and anti-inflammatory drugs for pain. As well, doctors may suggest lifestyle changes, such as diet and stress management.

What is prostate cancer?

Prostate cancer is a malignant tumour that grows in the prostate gland. If left untreated, it can spread to nearby lymph nodes, bones or organs.

Prostate cancer is found in about 10 per cent of men undergoing treatment for BPH and about 40 per cent of men with bladder cancer.

How fast the cancer spreads and exactly how it develops varies for each case. The survival rate depends on what stage the cancer is at when it's discovered but early diagnosis increases the chances that treatment will be successful.

In the past few years, five-year survival rates for all stages of prostate cancer have increased from 67 per cent to 99 per cent.

What are the symptoms?

Unfortunately, there are often no symptoms in the early stages of prostate cancer so men usually don't realize they have it. Symptoms usually don't occur until the cancer has spread beyond the prostate. The Prostate Cancer Research Foundation of Canada recommends that men contact their doctor if they experience one or more of the following symptoms: 

• Frequent, difficult, or painful urination. 
• Blood or pus in the urine.
• Pain in the lower back, pelvic area, or upper thighs. 
• Painful ejaculation.

The good news is that the expression "more men die with prostate cancer, than of it" is more than just a catch phrase. For every three men who develop the disease, two of them will die of something else.

What causes prostate cancer?

Nobody knows for sure, which makes it difficult to determine how to prevent the disease. Researchers have determined that eating animal fat is a risk factor, which means the answer, or at least part of it, may lie in diet. They suggest cutting down on fatty foods and eating more fruits, vegetables and grains.

A study released on Dec. 9, 2008 — a month before it was due to be published in the Journal of the American Medical Association — found that taking vitamin E or C supplements over the long-term does not reduce the risk of developing prostate or other cancers.  The authors said study was being released early because of public health implications. The study concluded that there is no statistical support for the use of supplements for the prevention of cancer in middle-aged and older men.

What are the risk factors?

Age. The risk of developing the disease increases as you age. More than 70 per cent of all prostate cancers are diagnosed in men older than 65.

Family history is another indicator. If your father or brother had the disease, you are up to 11 times more likely to develop it.

As well, the death rate for prostate cancer is nearly 2.4 times higher in African-Canadians than in Caucasians. And obese men also have a higher death rate from the disease.

What tests are available?

Routine prostate testing is one of those responsibilities men take on when they hit 50 — 45 if you're in a higher risk group.

There are two types of recommended tests:

Rectal exam: Your doctor can feel the prostate with a gloved, lubricated finger in the rectum. It helps the doctor determine if the prostate is enlarged, or has lumps or other types of abnormal texture.

Prostate-specific antigen (PSA) test: Prostate-specific antigen is a substance produced by prostate cells. A PSA test measures the level of PSA in the bloodstream. If your level is above a certain point, it could indicate prostate cancer. Further testing would be required. But higher than normal PSA levels does not necessarily mean you have prostate cancer.

Transrectal ultrasound: this is used to detect abnormal prostate growth. It uses sound waves to create an image of the prostate.

Biopsy: a tissue sample is removed for further testing. It is the only way to confirm whether prostate cancer is present.

A recently identified blood protein may offer a more accurate way to identify prostate cancer than the standard PSA test. A team of researchers from Johns Hopkins University School of Medicine in Baltimore has developed a test that looks at another antigen, called EPCA-2, or early prostate cancer antigen-2. It detected 94 per cent of the men with prostate cancer in a test group. The test will undergo further trials.

What is the treatment?

Depending on how far the disease has progressed, treatment can vary from hormonal therapy, surgery, radiation, chemotherapy, or "watchful waiting."

The goal of hormonal therapy is to block the effect of male hormones, such as testosterone. That, in turn, can slow the growth of hormone-dependent prostate cancer cells. Hormonal therapy is not a cure for prostate cancer.

The goal of surgery is to remove all of the cancer. Part or all of the prostate may be removed. Side effects of radical prostatectomy - removal of the entire prostate gland - can include urinary incontinence and impotence.

Success of preserving potency depends on a man's age, the status of the nerves and muscular tissue, and the stage of the cancer. But nerves can't always be spared during surgery — especially if the cancer is too large or too close to the nerves.